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About the Role

Initiate, negotiate, and execute physician, hospital, and other provider contracts and agreements for a health insurance organization. Report to the Director, Provider Contracting.

Responsibilities

• Lead negotiations for hospital and health system agreements, including reimbursement, contract terms, amendments, renewals, and value based agreements.
• Partner with Finance, Medical Economics, Legal, Network Management, Claims, Configuration, and Operations to ensure contracts are financially sound and operationally executable.
• Communicate contract terms, payment structures, and reimbursement rates to providers.
• Analyze financial impact of contracts and terms.
• Maintain contracts and documentation within a tracking system.
• Help identify and recruit providers based on network composition and needs.

Requirements

• Bachelor's degree
• 5 or more years of Hospital negotiation experience in Medicare
• Leading negotiations for hospital and health system agreements, including reimbursement, contract terms, amendments, renewals, and value based agreements
• 5 or more years of progressive network management experience including hospital contracting and network administration in a healthcare company
• Experienced in negotiating managed care contracts with Hospital systems inclusive of post acute, ancillary providers and physicians.
• Analyze, understand and communicate financial impact of contract terms, payment structures and reimbursement rates to providers.
• Understand and interpret Hospital contract language
• Proficient in Microsoft Office: Word, Excel and PowerPoint

Skills

• Managed care experience
• Hospital contracting
• Reimbursement methodologies
• Financial analysis
• Complex negotiations
• Provider relationship management
• Leadership
• Medicare Advantage
• Medicaid
• Value based-contracting
• DRG
• PD
• Case Rates
• POC
• OP fee schedules
• Alternative payment arrangements
• ACO/Risk Contracting

Location

• Work at Home

Work Type

• Remote
• Full-time

Experience Level

• Senior
• 5 or more years

Education Level

• Bachelor's degree
• Master's Degree

Salary/Compensations

• $78,400 - $107,800 per year

Benefits

• Medical benefits
• Dental benefits
• Vision benefits
• 401(k) retirement savings plan
• Time off
• Paid time off
• Company holidays
• Personal holidays
• Paid parental leave
• Paid caregiver leave
• Short-term disability
• Long-term disability
• Life insurance

About the Company

• CarePlus Health Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years.
• CarePlus strives to help people with Medicare, or both Medicare and Medicaid, achieve their best possible health and wellness through plans with benefits and services they care about.
• As a wholly owned subsidiary of Humana, CarePlus currently serves Medicare beneficiaries throughout 21 Florida counties.
• Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company.
• Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it.
• These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity

• It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status.
• It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements.
• This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.